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A CMS plan to consolidate state health care quality control groups into regions is opposed by Columbia, Mo.-based Primaris, which oversees quality control for hospitals in the state. CEO Richard Royer said he is working with the state's congressional delegation to get hearings on the plan. State models allow programs to meet the needs of their residents, he said.

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The CMS has introduced its eHealth Eligibility Assessment Tool designed to help eligible professionals find the most appropriate eHealth initiatives they can join. The tool can be found at the agency's eHealth website.

Five years after a Missouri Supreme Court decision supported the legality of midwives, the state Health Department says out-of-hospital births have increased 68%. The number of births attended by certified professional midwives has doubled over the past two years. Private insurers are working to cover these deliveries, though Medicaid will not pay for births outside of hospitals.

Missouri health systems are participating in accountable care organization projects to test the new care coordination and provider payment system. Mercy Health began participating in a CMS pilot in 2005. An official with the system said higher quality of care meant higher costs, at least in the short term. Mercy has been named among more than 100 participants in the next ACO initiative, which will emphasize preventive care and early intervention.

Missouri state Sen. Scott Rupp, chairman of the state Senate Interim Committee on Health Insurance Exchanges, said the U.S. Supreme Court's review of the health care law, and the Senate's political makeup, means it's unlikely that the state will proceed with forming a health insurance exchange. "We're a sovereign state, and we will do things that we see best for Missourians, and if that doesn’t coincide with the federal government's timeline or wish list, then so be it," Rupp said.